Initial Management of Orthopedic Trauma: What You Need to Know

 

Barasat: Orthopedic trauma, such as fractures, dislocations, or severe musculoskeletal injuries, requires quick and effective management. In emergencies, handling these injuries properly can make a significant difference in recovery, long-term function, and overall patient outcomes. Whether it’s a broken bone or a traumatic joint injury, the first few steps in managing these injuries are critical.

 

So, let’s dive into the essentials of orthopedic trauma management.

 

The ABCs of Trauma Care-When it comes to managing any kind of trauma, including orthopedic injuries, we follow the ABCDE principles of the Advanced Trauma Life Support (ATLS) guidelines. These steps ensure that all life-threatening injuries are addressed promptly, and that care is systematic and effective.

 

1) Airway with Cervical Spine Protection:

•The first step is always to ensure the airway is open and clear. Trauma patients, especially those involved in high-impact events like car crashes or falls, are at risk of airway compromise.

•Cervical spine protection is essential in orthopedic trauma cases. An undiagnosed neck injury can lead to severe complications, so immobilizing the spine until cleared by imaging is crucial.

 

2) Breathing and Ventilation:

•After securing the airway, make sure the patient is breathing adequately. Trauma to the chest, like rib fractures, can make breathing painful and inefficient. Oxygen may be necessary, and for severe cases, you might need to intervene more aggressively.

 

3) Circulation with Hemorrhage Control:

•Stopping the bleed is one of the most important aspects of trauma care. Severe orthopedic injuries, especially fractures of large bones like the femur, can lead to significant internal or external bleeding.

•Controlling bleeding through direct pressure, tourniquets, or wound packing is vital, but don’t forget about fracture stabilization. Splinting the limb helps reduce movement, which not only decreases pain but also minimizes further tissue damage and bleeding.

 

4) Disability (Neurological Evaluation):

•A quick neurological check is essential. Can the patient move their fingers and toes? Do they have sensation in the injured limb? Orthopedic injuries, especially near joints or the spine, can sometimes lead to nerve damage.

•Documenting any deficits early helps track changes and guides further treatment.

 

5) Exposure and Environmental Control:

•You need to fully expose the patient to inspect all injuries, but at the same time, prevent hypothermia. A trauma patient is already vulnerable, and losing body heat can make things worse. Use blankets and warming devices once you’ve done your assessment.

 

The Basics of Orthopedic Trauma Management-Once the patient’s immediate life-threatening issues are addressed, it’s time to focus on the orthopedic injury itself. Here are the essential steps:

 

1. Immobilization: Stabilizing the injury is crucial. For fractures, dislocations, or severe sprains, splinting the affected area reduces further damage, prevents worsening of the injury, and helps manage pain. If the injury involves the spine or pelvis, specialized immobilization techniques may be necessary to avoid further complications.

 

2. Pain Management: Trauma hurts. And managing pain is essential not just for the patient’s comfort, but also for improving their ability to cooperate with other interventions. Depending on the injury, you might use over-the-counter painkillers, stronger analgesics like opioids, or even nerve blocks for localized relief.

 

3. Imaging: After the patient is stabilized, imaging like X-rays or CT scans becomes the next priority. These will provide a clearer picture of the injury—whether it’s a simple break, a complex fracture, or a dislocation that needs reduction.

 

4. Tetanus and Antibiotics: If there’s an open fracture or significant wounds, tetanus prophylaxis is a must. Open fractures are also prone to infection, so early administration of broad-spectrum antibiotics can help prevent serious infections like osteomyelitis.

 

5. Definitive Care: Orthopedic injuries may require more than just splinting. Depending on the severity of the trauma, surgical interventions might be necessary, such as internal fixation with plates or screws, or external fixation in case of open fractures followed by delayed definitive fixation.

 

In these ways we can manage a trauma patient in a health care set up at initial presentation.

 

Dr. Sourav Saha, Consultant, Orthopedic & Joint Replacement, Narayana Hospital Barasat